{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,2]],"date-time":"2025-08-02T18:53:41Z","timestamp":1754160821813,"version":"3.41.2"},"reference-count":26,"publisher":"BMJ","issue":"7","license":[{"start":{"date-parts":[[2025,7,27]],"date-time":"2025-07-27T00:00:00Z","timestamp":1753574400000},"content-version":"unspecified","delay-in-days":26,"URL":"https:\/\/creativecommons.org\/licenses\/by\/3.0\/igo\/"}],"funder":[{"DOI":"10.13039\/100000865","name":"Bill and Melinda Gates Foundation","doi-asserted-by":"publisher","award":["1126331"],"award-info":[{"award-number":["1126331"]}],"id":[{"id":"10.13039\/100000865","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Glob Health"],"accepted":{"date-parts":[[2025,7,1]]},"published-print":{"date-parts":[[2025,7]]},"abstract":"<jats:sec>\n                  <jats:title>Introduction<\/jats:title>\n                  <jats:p>One of the leading causes of global child mortality continues to be diarrhoea where rotavirus contributed to about 24% of deaths among all diarrhoeal deaths, mostly in low-income and middle-income countries. Rotavirus vaccination programmes have contributed to the reduction of mortality from 24% to 19% in rotavirus infections among hospitalised children, but the burden of rotaviral diarrhoea remains high, especially in settings with undernutrition. We aimed to determine the association of rotaviral diarrhoea aetiology with prior vaccination, socioeconomic status and clinical factors in children to see their utility in clinical settings.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We analysed secondary data from a multicentre clinical trial on antibiotic impact in children with diarrhoea and increased risk of mortality. We used stored stool samples of 6697 children aged 2\u201323 months old, presenting to a health facility with diarrhoea and increased risk of mortality. We determined rotavirus aetiology prevalence using quantitative PCR (qPCR) and looked at its association with the patient\u2019s rotaviral vaccination status, clinical symptoms and sociodemographic characteristics. Prevalence ratios (PR) were calculated with log-binomial regression models; if they did not converge, log-Poisson models were used.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Rotavirus prevalence of 21.1% was observed. There was a weak and statistically non-significant inverse association between rotavirus vaccination and rotaviral diarrhoea aetiology (adjusted PR: 0.71, 95%\u2009CI 0.49 to 1.03). Of the five tested clinical symptoms, shorter diarrhoea duration was associated with rotaviral aetiology (PR: 2.65; 95%\u2009CI: 1.29 to 5.45). Of the seven tested socioeconomic characteristics, only maternal and paternal secondary education compared with no formal education were associated with rotaviral aetiology (PR: 0.86; 95%\u2009CI: 0.74 to 1.00, PR: 0.87, 95%\u2009CI: 0.75 to 1.00 respectively).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>Rotaviral diarrhoea aetiology cannot accurately be determined with prior receipt of rotavirus vaccination among children presenting to facilities with diarrhoea and increased risk of mortality. Short diarrhoea duration and parental secondary education were associated with increased prevalence of rotaviral aetiology; however, their utility in clinical care remains unclear.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/bmjgh-2024-018337","type":"journal-article","created":{"date-parts":[[2025,7,28]],"date-time":"2025-07-28T01:15:16Z","timestamp":1753665316000},"page":"e018337","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Is rotavirus aetiology in young children with acute diarrhoea associated with sociodemographic and clinical factors, including rotavirus vaccination status? A secondary cross-sectional analysis of the ABCD trial"],"prefix":"10.1136","volume":"10","clinical-trial-number":[{"clinical-trial-number":"nct03130114","registry":"10.18810\/clinical-trials-gov"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6031-830X","authenticated-orcid":false,"given":"Sarah","family":"Somji","sequence":"first","affiliation":[{"name":"Department of Epidemiology and Biostatistics, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania, United Republic of"},{"name":"Center for Child, Adolescent, Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University and Tampere University Hospital, Tampere University and Tampere University Hospital, Tampere, Finland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christopher R","family":"Sudfeld","sequence":"additional","affiliation":[{"name":"Departments of Global Health and Population and Nutrition, Harvard School of Public Health, Boston, Massachusetts, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christopher","family":"Duggan","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology, Hepatology and Nutrition, Boston Children\u2019s Hospital, Boston, Massachusetts, USA"},{"name":"Departments of Global Health and Population and Nutrition, Harvard T H Chan School of Public Health, Boston, Massachusetts, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Karim","family":"Manji","sequence":"additional","affiliation":[{"name":"Department of Paediatrics and Child Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania, United Republic of"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tahmeed","family":"Ahmed","sequence":"additional","affiliation":[{"name":"Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Bangladesh"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mohammod Jobayer","family":"Chisti","sequence":"additional","affiliation":[{"name":"Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-6168-5157","authenticated-orcid":false,"given":"Usha","family":"Dhingra","sequence":"additional","affiliation":[{"name":"Center for Public Health Kinetics, New Delhi, New Delhi, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8035-9085","authenticated-orcid":false,"given":"Sunil","family":"Sazawal","sequence":"additional","affiliation":[{"name":"Center for Public Health Kinetics, New Delhi, New Delhi, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6605-324X","authenticated-orcid":false,"given":"Benson","family":"Singa","sequence":"additional","affiliation":[{"name":"Center for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Judd L","family":"Walson","sequence":"additional","affiliation":[{"name":"Department of Global Health and Epidemiology, University of Washington, Seattle, Washington, USA"},{"name":"Department of Pediatrics and Medicine (Infectious Diseases), University of Washington, Seattle, Washington, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Patricia B","family":"Pavlinac","sequence":"additional","affiliation":[{"name":"Departments of Global Health, University of Washington, Seattle, Washington, USA"},{"name":"Department of Epidemiology, University of Washington, Seattle, Washington, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Naor","family":"Bar-Zeev","sequence":"additional","affiliation":[{"name":"International Vaccine Access Center, Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eric","family":"Houpt","sequence":"additional","affiliation":[{"name":"Department of Medicine, Infectious Diseases, International Health, University of Virginia, Charlottesville, Virginia, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Queen","family":"Dube","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Queen Elizabeth Central Hospital, Blantyre, Southern Region, Malawi"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Karen L","family":"Kotloff","sequence":"additional","affiliation":[{"name":"Center for Vaccine Development and Global Health, University of Maryland Baltimore School of Medicine, Baltimore, Maryland, USA"},{"name":"Department of Pediatrics, University of Maryland Baltimore School of Medicine, Baltimore, Maryland, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Samba O","family":"Sow","sequence":"additional","affiliation":[{"name":"Centre pour le D\u00e9veloppement des Vaccines, Bamako, Mali"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mohammad Tahir","family":"Yousafzai","sequence":"additional","affiliation":[{"name":"Department of Pediatrics and Child Heath, The Aga Khan University, Karachi, Pakistan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Farah Naz","family":"Qamar","sequence":"additional","affiliation":[{"name":"Department of Pediatrics and Child Heath, The Aga Khan University, Karachi, Pakistan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rajiv","family":"Bahl","sequence":"additional","affiliation":[{"name":"Department of Maternal, Child, and Adolescent Health and Aging, World Health Organization, Geneva, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ayesha","family":"De Costa","sequence":"additional","affiliation":[{"name":"Department of Maternal, Newborn, Child and Adolescent Health, and Ageing, World Health Organization, Geneve, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6740-549X","authenticated-orcid":false,"given":"Jonathon L","family":"Simon","sequence":"additional","affiliation":[{"name":"Department of Maternal, Child, and Adolescent Health and Aging, World Health Organization, Geneva, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2311-2593","authenticated-orcid":false,"given":"Per","family":"Ashorn","sequence":"additional","affiliation":[{"name":"Center for Child, Adolescent, Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2025,7,27]]},"reference":[{"key":"2025072718150956000_10.7.e018337.1","unstructured":"UNICEF DATA . 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CDC; 2022. Available: https:\/\/www.cdc.gov\/vaccines\/pubs\/pinkbook\/rota.html [Accessed 30 May 2024]."},{"key":"2025072718150956000_10.7.e018337.18","doi-asserted-by":"publisher","DOI":"10.29063\/ajrh2017\/v21i3.2"},{"key":"2025072718150956000_10.7.e018337.19","unstructured":"Health disparities | DASH. CDC. Available: https:\/\/www.cdc.gov\/healthyyouth\/disparities\/index.htm [Accessed 30 May 2024]."},{"key":"2025072718150956000_10.7.e018337.20","doi-asserted-by":"crossref","DOI":"10.1016\/j.eclinm.2021.101173","article-title":"Associations between biomarkers of environmental enteric dysfunction and oral rotavirus vaccine immunogenicity in rural Zimbabwean infants","volume":"41","author":"Church","year":"2021","journal-title":"EClinicalMedicine"},{"key":"2025072718150956000_10.7.e018337.21","doi-asserted-by":"publisher","DOI":"10.1097\/INF.0000000000000427"},{"key":"2025072718150956000_10.7.e018337.22","doi-asserted-by":"crossref","DOI":"10.3390\/pathogens6040065","article-title":"Differences of Rotavirus Vaccine Effectiveness by Country: Likely Causes and Contributing Factors","volume":"6","author":"Desselberger","year":"2017","journal-title":"Pathogens"},{"key":"2025072718150956000_10.7.e018337.23","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0041720","article-title":"Understanding reduced rotavirus vaccine efficacy in low socio-economic settings","volume":"7","author":"Lopman","year":"2012","journal-title":"PLoS One"},{"key":"2025072718150956000_10.7.e018337.24","doi-asserted-by":"publisher","DOI":"10.1097\/INF.0b013e3181967c29"},{"key":"2025072718150956000_10.7.e018337.25","doi-asserted-by":"crossref","first-page":"1759","DOI":"10.1016\/j.ebiom.2015.09.036","article-title":"Environmental Enteropathy, Oral Vaccine Failure and Growth Faltering in Infants in Bangladesh","volume":"2","author":"Naylor","year":"2015","journal-title":"EBioMedicine"},{"key":"2025072718150956000_10.7.e018337.26","doi-asserted-by":"publisher","DOI":"10.1097\/INF.0000000000001457"}],"container-title":["BMJ Global Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjgh-2024-018337","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,7,28]],"date-time":"2025-07-28T01:15:22Z","timestamp":1753665322000},"score":1,"resource":{"primary":{"URL":"https:\/\/gh.bmj.com\/lookup\/doi\/10.1136\/bmjgh-2024-018337"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,7]]},"references-count":26,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2025,7,27]]},"published-print":{"date-parts":[[2025,7]]}},"alternative-id":["10.1136\/bmjgh-2024-018337"],"URL":"https:\/\/doi.org\/10.1136\/bmjgh-2024-018337","relation":{},"ISSN":["2059-7908"],"issn-type":[{"type":"electronic","value":"2059-7908"}],"subject":[],"published":{"date-parts":[[2025,7]]}}}